Provider Demographics
NPI:1184858532
Name:BEACON FACIAL PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:BEACON FACIAL PLASTIC SURGERY, LLC
Other - Org Name:BFPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-697-5387
Mailing Address - Street 1:15 DIX ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1870
Mailing Address - Country:US
Mailing Address - Phone:617-694-6678
Mailing Address - Fax:
Practice Address - Street 1:15 DIX ST
Practice Address - Street 2:SUITE G
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1870
Practice Address - Country:US
Practice Address - Phone:617-694-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226898207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty